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\. t �- <br /> �ERMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS pARCEL TAX I.D.S PERMIT A� <br /> � E • '� �SlooS-cx�3 <br /> LEGA LOT Nu. BLOCK TRACT OR SUBDMSION# <br /> DESC. <br /> OWNER ApDRESS CITY2IP PHONE I.�Zc� — <br /> .sMoK-� K i N G 1 I�,'� �z�,2�,��,., w�-u a��, w� NYI-9Nrr <br /> TENANTNAME GONTACTFORPERMIT PHONE <br /> SMoKF K �NG ��f"f TatflMF� `125- FS'Lo — �4oa "� <br /> �' e•Ma� Jt�Ff @ clt,�ss1'49Ps� <br /> . <br /> �VM�C.�p Si6'!�� �-I �iS ('lTH �i. S,E.#aA �����w�} lt� �c <br /> CONTR.LICENSE V <br /> _�O�/AN Sl-`I33DP 9�,ro� (LS3�347- <br /> _ .Sr.29 <br /> USE OF U�LDING I — HEAT SOURCE CONTRACT PRlCE f1F WORK <br /> ��� � Eleclric _Gas Other �^ � �� <br /> C <br /> WORK DESCRIPTION <br /> � � ���1- R L�g}'�i C S� G�U O v e� �'�-lZC/c�i L S"(-lU 1'•-���4�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYpE OF FIXTURE OR ITEM <br /> _ Toilet AIC—airhandling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clolhes dryer <br /> _ Water heater Range hood <br /> Sink(service!bar/mop/elc.) Exhausl fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unil healer <br /> Drinking Fountain Boiler <br /> _ Floordrain Refrigeracion <br /> _ Grease lrap Woodstove <br /> Roof drains Other <br /> Other — — <br /> CITY OF EVE!tETT LOCAL SALES!AX CODE IS 3705 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or noL The granting of a permit does nol presume <br /> to give authoiity to violate or cancel the provision of any other state or local law reguiat�ng construction or the performance ot <br /> constru ' . at I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State tracto Law 18. 7 RCW and 296.200 WAC. <br /> 5 � � �O <br /> Signature of n r o u orized Agent D te � <br /> � � C rC�sr�no S+�ti �2 S!-ta Kl' k-1 uC. I/Z <br />